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Rubens M, Ramamoorthy V, Saxena A, Ruiz Pelaez JG, Chaparro S, Jimenez J. The impact of the Coronavirus disease 2019 on hospitalizations for coronary artery revascularization: results from California State Inpatient Database. Coron Artery Dis 2023; 34:146-153. [PMID: 36720023 DOI: 10.1097/mca.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) outbreak has negatively impacted routine cardiovascular care. In this study, we assessed the impact of COVID-19 pandemic on percutaneous coronary artery intervention (PCI) and coronary artery bypass grafting (CABG) hospitalizations and outcomes using a large database. METHODS The current study was a retrospective analysis of California State Inpatient Database (SID) during March-December of 2019 and 2020. All adult hospitalizations for coronary artery revascularization were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. The primary outcome was inhospital mortality, and secondary outcomes were hospital length of stay, stroke, acute kidney injury, and mechanical ventilation. Propensity score match analysis was done to compare adverse clinical outcomes. RESULTS PCI hospitalizations (relative decrease, 15.0%, P for trend <0.001) and CABG hospitalizations (relative decrease, 16.4%, P for trend <0.001) decreased from 2019 to 2020, while viral pneumonia hospitalizations increased (relative increase, 1751.6%, P for trend <0.001). Monthly PCI and CABG hospitalization showed decreasing trends from January 2019 to December 2020. Propensity score match analysis showed that the odds of inhospital mortality (OR, 1.12; 95% CI, 1.01-1.24), acute kidney injury (OR, 1.12; 95% CI, 1.06-1.17), and ARDS (OR, 1.89; 95% CI, 1.18-3.01) were higher among patients who received PCI in 2020. CONCLUSION Results of our study indicate that initiatives such as encouraging patients to receive treatments and controlling the spread of COVID-19 should be instituted to improve PCI and CABG hospitalizations.
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Affiliation(s)
- Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida
- Herbert Wertheim College of Medicine, Florida International University
| | | | - Anshul Saxena
- Herbert Wertheim College of Medicine, Florida International University
- Center for Advanced Analytics, Baptist Health South Florida
| | | | - Sandra Chaparro
- Herbert Wertheim College of Medicine, Florida International University
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Javier Jimenez
- Herbert Wertheim College of Medicine, Florida International University
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
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Hoefsmit PC, Schretlen S, Burchell G, van den Heuvel J, Bonjer J, Dahele M, Zandbergen R. Can Quality Improvement Methodologies Derived from Manufacturing Industry Improve Care in Cardiac Surgery? A Systematic Review. J Clin Med 2022; 11:jcm11185350. [PMID: 36142997 PMCID: PMC9502537 DOI: 10.3390/jcm11185350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Healthcare is required to be effectively organised to ensure that growing, aging and medically more complex populations have timely access to high-quality, affordable care. Cardiac surgery is no exception to this, especially due to the competition for and demand on hospital resources, such as operating rooms and intensive care capacity. This is challenged more since the COVID-19 pandemic led to postponed care and prolonged waiting lists. In other sectors, Quality Improvement Methodologies (QIM) derived from the manufacturing industry have proven effective in enabling more efficient utilisation of existing capacity and resources and in improving the quality of care. We performed a systematic review to evaluate the ability of such QIM to improve care in cardiac surgery. Methods: A literature search was performed in PubMed, Embase, Clarivate Analytics/Web of Science Core Collection and Wiley/the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology. Results: Ten articles were identified. The following QIM were used: Lean, Toyota Production System, Six Sigma, Lean Six Sigma, Root Cause Analysis, Kaizen and Plan-Do-Study-Act. All reported one or more relevant improvements in patient-related (e.g., infection rates, ventilation time, mortality, adverse events, glycaemic control) and process-related outcomes (e.g., shorter waiting times, shorter transfer time and productivity). Elements to enhance the success included: multidisciplinary team engagement, a patient-oriented, data-driven approach, a sense of urgency and a focus on sustainability. Conclusions: In all ten papers describing the application of QIM initiatives to cardiac surgery, positive results, of varying magnitude, were reported. While the consistency of the available data is encouraging, the limited quantity and heterogenous quality of the evidence base highlights that more rigorous evaluation, including how best to employ manufacturing industry-derived QIM in cardiac surgery is warranted.
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Affiliation(s)
- Paulien Christine Hoefsmit
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - Stijn Schretlen
- Integrated Health Solutions, Medtronic Inc., 5616 VB Eindhoven, The Netherlands
| | - George Burchell
- Medical Library, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Jaap van den Heuvel
- Department of Healthcare Management, University of Amsterdam Business School, 1018 TV Amsterdam, The Netherlands
| | - Jaap Bonjer
- Department of Surgery, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Reinier Zandbergen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Centre, 1081 HV Amsterdam, The Netherlands
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Hardiman SC, Villan Villan YF, Conway JM, Sheehan KJ, Sobolev B. Factors affecting mortality after coronary bypass surgery: a scoping review. J Cardiothorac Surg 2022; 17:45. [PMID: 35313895 PMCID: PMC8935749 DOI: 10.1186/s13019-022-01784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Previous research reports numerous factors of post-operative mortality in patients undergoing isolated coronary artery bypass graft surgery. However, this evidence has not been mapped to the conceptual framework of care improvement. Without such mapping, interventions designed to improve care quality remain unfounded. Methods We identified reported factors of in-hospital mortality post isolated coronary artery bypass graft surgery in adults over the age of 19, published in English between January 1, 2000 and December 31, 2019, indexed in PubMed, CINAHL, and EMBASE. We grouped factors and their underlying mechanism for association with in-hospital mortality according to the augmented Donabedian framework for quality of care. Results We selected 52 factors reported in 83 articles and mapped them by case-mix, structure, process, and intermediary outcomes. The most reported factors were related to case-mix (characteristics of patients, their disease, and their preoperative health status) (37 articles, 27 factors). Factors related to care processes (27 articles, 12 factors) and structures (11 articles, 6 factors) were reported less frequently; most proposed mechanisms for their mortality effects. Conclusions Few papers reported on factors of in-hospital mortality related to structures and processes of care, where intervention for care quality improvement is possible. Therefore, there is limited evidence to support quality improvement efforts that will reduce variation in mortality after coronary artery bypass graft surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01784-z.
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Parcha V, Kalra R, Glenn AM, Davies JE, Kuranz S, Arora G, Arora P. Coronary artery bypass graft surgery outcomes in the United States: Impact of the coronavirus disease 2019 (COVID-19) pandemic. ACTA ACUST UNITED AC 2021; 6:132-143. [PMID: 33870234 PMCID: PMC8007527 DOI: 10.1016/j.xjon.2021.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
Objective There has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease 2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 COVID-19 pandemic period and compare the risks with those undergoing CABG before the pandemic in the year 2019. Methods A retrospective cross-sectional analysis of the TriNetX Research Network database was performed. Patients undergoing CABG between January 20, 2019, and September 15, 2019, contributed to the 2019 cohort, and those undergoing CABG between January 20, 2020, and September 15, 2020, contributed to the 2020 cohort. Propensity-score matching was performed, and the odds of mortality, acute kidney injury, stroke, acute respiratory distress syndrome, and mechanical ventilation occurring by 30 days were evaluated. Results The number of patients undergoing CABG in 2020 declined by 35.5% from 5534 patients in 2019 to 3569 patients in 2020. After propensity-score matching, 3569 patient pairs were identified in the 2019 and the 2020 cohorts. Compared with those undergoing CABG in 2019, the odds of mortality by 30 days were 0.96 (95% confidence interval [CI], 0.69-1.33; P = .80) in those undergoing CABG in 2020. The odds for stroke (odds ratio [OR], 1.201; 95% CI, 0.96-1.39), acute kidney injury (OR, 0.76; 95% CI, 0.59-1.08), acute respiratory distress syndrome (OR, 1.01; 95% CI, 0.60-2.42), and mechanical ventilation (OR, 1.11; 95% CI, 0.94-1.30) were similar between the 2 cohorts. Conclusions The number of patients undergoing CABG in 2020 has substantially declined compared with 2019. Similar odds of adverse clinical outcomes were seen among patients undergoing CABG in the setting of COVID-19 compared with those in 2019.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, Minn
| | - Austin M Glenn
- School of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Ala
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Zheng NS, Warner JL, Osterman TJ, Wells QS, Shu XO, Deppen SA, Karp SJ, Dwyer S, Feng Q, Cox NJ, Peterson JF, Stein CM, Roden DM, Johnson KB, Wei WQ. A retrospective approach to evaluating potential adverse outcomes associated with delay of procedures for cardiovascular and cancer-related diagnoses in the context of COVID-19. J Biomed Inform 2021; 113:103657. [PMID: 33309899 PMCID: PMC7728428 DOI: 10.1016/j.jbi.2020.103657] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/10/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE During the COVID-19 pandemic, health systems postponed non-essential medical procedures to accommodate surge of critically-ill patients. The long-term consequences of delaying procedures in response to COVID-19 remains unknown. We developed a high-throughput approach to understand the impact of delaying procedures on patient health outcomes using electronic health record (EHR) data. MATERIALS AND METHODS We used EHR data from Vanderbilt University Medical Center's (VUMC) Research and Synthetic Derivatives. Elective procedures and non-urgent visits were suspended at VUMC between March 18, 2020 and April 24, 2020. Surgical procedure data from this period were compared to a similar timeframe in 2019. Potential adverse impact of delay in cardiovascular and cancer-related procedures was evaluated using EHR data collected from January 1, 1993 to March 17, 2020. For surgical procedure delay, outcomes included length of hospitalization (days), mortality during hospitalization, and readmission within six months. For screening procedure delay, outcomes included 5-year survival and cancer stage at diagnosis. RESULTS We identified 416 surgical procedures that were negatively impacted during the COVID-19 pandemic compared to the same timeframe in 2019. Using retrospective data, we found 27 significant associations between procedure delay and adverse patient outcomes. Clinician review indicated that 88.9% of the significant associations were plausible and potentially clinically significant. Analytic pipelines for this study are available online. CONCLUSION Our approach enables health systems to identify medical procedures affected by the COVID-19 pandemic and evaluate the effect of delay, enabling them to communicate effectively with patients and prioritize rescheduling to minimize adverse patient outcomes.
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Affiliation(s)
- Neil S Zheng
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeremy L Warner
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis J Osterman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth J Karp
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shon Dwyer
- Vanderbilt University Adult Hospital, Vanderbilt University Medical Center, Nashville, TN, USA
| | - QiPing Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nancy J Cox
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Josh F Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
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Eltorai AEM, Baird GL, Eltorai AS, Healey TT, Agarwal S, Ventetuolo CE, Martin TJ, Chen J, Kazemi L, Keable CA, Diaz E, Pangborn J, Fox J, Connors K, Sellke FW, Elias JA, Daniels AH. Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting: A Randomized Clinical Trial. JAMA Surg 2020; 154:579-588. [PMID: 30969332 DOI: 10.1001/jamasurg.2019.0520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Incentive spirometers (ISs) were developed to reduce atelectasis and are in widespread clinical use. However, without IS use adherence data, the effectiveness of IS cannot be determined. Objective To evaluate the effect of a use-tracking IS reminder on patient adherence and clinical outcomes following coronary artery bypass grafting (CABG) surgery. Design, Setting, and Participants This randomized clinical trial was conducted from June 5, 2017, to December 29, 2017, at a tertiary referral teaching hospital and included 212 patients who underwent CABG, of whom 160 participants were randomized (intent to treat), with 145 completing the study per protocol. Participants were stratified by surgical urgency (elective vs nonelective) and sex (men vs women). Interventions A use-tracking, IS add-on device (SpiroTimer) with an integrated use reminder bell recorded and timestamped participants' inspiratory breaths. Patients were randomized by hourly reminder "bell on" (experimental group) or "bell off" (control group). Main Outcomes and Measures Incentive spirometer use was recorded for the entire postoperative stay and compared between groups. Radiographic atelectasis severity (score, 0-10) was the primary clinical outcome. Secondary respiratory and nonrespiratory outcomes were also evaluated. Results A total of 145 per-protocol participants (112 men [77%]; mean age, 69 years [95% CI, 67-70]; 90 [62%] undergoing a nonelective procedure) were evaluated, with 74 (51.0%) in the bell off group and 71 (49.0%) in the bell on group. The baseline medical and motivation-to-recover characteristics of the 2 groups were similar. The mean number of daily inspiratory breaths was greater in bell on (35; 95% CI, 29-43 vs 17; 95% CI, 13-23; P < .001). The percentage of recorded hours with an inspiratory breath event was greater in bell on (58%; 95% CI, 51-65 vs 28%; 95% CI, 23-32; P < .001). Despite no differences in the first postoperative chest radiograph mean atelectasis severity scores (2.3; 95% CI, 2.0-2.6 vs 2.4; 95% CI, 2.2-2.7; P = .48), the mean atelectasis severity scores for the final chest radiographs conducted before discharge were significantly lower for bell on than bell off group (1.5; 95% CI, 1.3-1.8 vs 1.8; 95% CI, 1.6-2.1; P = .04). Of those with early postoperative fevers, fever duration was shorter for bell on (3.2 hours; 95% CI, 2.3-4.6 vs 5.2 hours; 95% CI, 3.9-7.0; P = .04). Having the bell turned on reduced noninvasive positive pressure ventilation use rates (37.2%; 95% CI, 24.1%-52.5% vs 19.2%; 95% CI, 10.2%-33.0%; P = .03) for participants undergoing nonelective procedures. Bell on reduced the median postoperative length of stay (7 days; 95% CI, 6-9 vs 6 days; 95% CI, 6-7; P = .048) and the intensive care unit length of stay for patients undergoing nonelective procedures (4 days; 95% CI, 3-5 vs 3 days; 95% CI, 3-4; P = .02). At 6 months, the bell off mortality rate was higher than bell on (9% vs 0%, P = .048) for participants undergoing nonelective procedures. Conclusions and Relevance The incentive spirometer reminder improved patient adherence, atelectasis severity, early postoperative fever duration, noninvasive positive pressure ventilation use, ICU and length of stay, and 6-month mortality in certain patients. With the reminder, IS appears to be clinically effective when used appropriately. Trial Registration ClinicalTrials.gov identifier: NCT02952027.
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Affiliation(s)
- Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Grayson L Baird
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Terrance T Healey
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Saurabh Agarwal
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Corey E Ventetuolo
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas J Martin
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jane Chen
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Layla Kazemi
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Catherine A Keable
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emily Diaz
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joshua Pangborn
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jordan Fox
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin Connors
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Frank W Sellke
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack A Elias
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Blaudszun G, Vuylsteke A, Gerrard C, Zochios V, Jenkins D, Valchanov K. Patients Discharged From the Intensive Care Unit on a Dopamine Infusion-A Retrospective, Observational Study. J Cardiothorac Vasc Anesth 2017; 31:1676-1680. [PMID: 28843607 DOI: 10.1053/j.jvca.2017.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the safety of discharging cardiac surgical patients from the intensive care unit (ICU) to wards while the patients are still receiving a dopamine infusion. DESIGN Retrospective, observational study. SETTING Cardiothoracic ICU of a tertiary academic hospital in the United Kingdom. PARTICIPANTS The study comprised all cardiac surgical patients older than 18 years and admitted between September 1, 2015 and September 16, 2016 to the ICU and subsequently discharged to a surgical ward. Patients were divided in the following 2 groups: a dopamine group with patients discharged with a dopamine infusion and a control group with patients discharged without any dopamine infusion. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The hospital mortality rate was comparable in both groups (0.7% in the dopamine group v 0.2% in the control group [p = 0.11]), despite that the median logistic EuroSCORE was significantly higher in the dopamine group (7.0 v 3.8 [p < 0.01]). The ICU readmission rate was higher in the dopamine group (6.6% v 2.4%; p < 0.01). ICU and hospital lengths of stay were longer in the dopamine group (1.7 v 0.9 days [p < 0.01] and 11.4 v 8.0 days [p < 0.01], respectively). CONCLUSIONS Despite a higher ICU readmission rate, ICU discharge of patients on dopamine infusion was not associated with increased mortality.
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Affiliation(s)
- Grégoire Blaudszun
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
| | - Alain Vuylsteke
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Caroline Gerrard
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Vasileios Zochios
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham College of Medical and Dental Sciences, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - David Jenkins
- Department of Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Kamen Valchanov
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Head SJ, da Costa BR, Beumer B, Stefanini GG, Alfonso F, Clemmensen PM, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Kappetein AP, Kastrati A, Knuuti J, Kolh P, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A, Windecker S, Jüni P, Sousa-Uva M. Adverse events while awaiting myocardial revascularization: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017; 52:206-217. [PMID: 28472484 DOI: 10.1093/ejcts/ezx115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 03/17/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Berend Beumer
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Peter M Clemmensen
- Department of Medicine, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark
| | - Jean-Philippe Collet
- ACTION Study Group, Université Pierre et Marie Curie (UPMC-Paris 06), Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Jochen Cremer
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Klinik für Herz-Thorax-Gefässchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart and Thoraxenter, Bad Nauheim, Germany
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Philippe Kolh
- Department of Cardiovascular Surgery, University Hospital of Liege, Liege, Belgium
| | - Ulf Landmesser
- Department of Cardiology, Charité Berlin-University Medicine, Campus Benjamin Franklin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | | | - Patrick Schauerte
- Department of Cardiology, University Hospital Aachen RWTH, Aachen, Germany
| | - David P Taggart
- Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Lucia Torracca
- Cardio Center, Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - William Wijns
- Cardiovascular Research Center, OLV Hospital Aalst, Aalst, Belgium
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Cruz Vermelha, Lisbon, Portugal
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Neves J, Pereira H, Sousa Uva M, Gavina C, Leite-Moreira A, Loureiro MJ. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Neves J, Pereira H, Sousa Uva M, Gavina C, Leite Moreira A, Loureiro MJ. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery. Rev Port Cardiol 2015; 34:683-9. [PMID: 26481182 DOI: 10.1016/j.repc.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022] Open
Abstract
Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources.
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Affiliation(s)
- José Neves
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal.
| | - Hélder Pereira
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Miguel Sousa Uva
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Cristina Gavina
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Adelino Leite Moreira
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Maria José Loureiro
- Sociedade Portuguesa de Cirurgia Cardio-Torácica e Vascular e Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
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Amado J, Bento D, Silva D, Chin J, Marques N, Gago P, Mimoso J, de Jesus I. Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Amado J, Bento D, Silva D, Chin J, Marques N, Gago P, Mimoso J, de Jesus I. Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos? Rev Port Cardiol 2015; 34:575-81. [DOI: 10.1016/j.repc.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022] Open
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Microvolt T-wave alternans in patients undergoing elective coronary artery bypass grafting: a pilot study. HEART, LUNG AND VESSELS 2015; 7:27-34. [PMID: 25861588 PMCID: PMC4381820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We designed a prospective observational study targeting a selective population of patients undergoing elective coronary artery bypass grafting with normal systolic function. In this study we looked at the prevalence of pre-operative microvolt T-wave alternans and if it predicts atrial fibrillation after surgery. METHODS The inclusion criteria included all patients referred to the cardiothoracic outpatient clinic for elective bypass, who can perform aerobic exercise, with a recent exercise stress test exercising at least to 85% of the maximal predicted heart rate (220 - age) and with non-limiting chest pain at maximal exercise. Twenty patients met the inclusion/exclusion criteria between May 2008 and February 2010. The hospital course of those patients was followed, and in-hospital events were recorded. RESULTS Nine out twenty (45%) of patients had a non-negative microvolt T-wave alternans tracing. Six patients (30%) developed new onset atrial fibrillation post surgery. Patients with non-negative microvolt level T-wave alternans are more likely to develop atrial fibrillation post coronary artery bypass grafting then patients with negative microvolt level T-wave alternans (p=0.05). CONCLUSIONS This pilot study provides the first clinical evidence that patients with ischemic heart disease and normal systolic function have a high prevalence of abnormal microvolt T-wave alternans and might be at higher risk of sudden cardiac death. In addition our results show that microvolt level T-wave alternans predicts post coronary artery bypass grafting new onset atrial fibrillation.
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Manji RA, Jacobsohn E, Grocott HP, Menkis AH. Longer in-hospital wait times do not result in worse outcomes for patients requiring urgent coronary artery bypass graft surgery. Hosp Pract (1995) 2013; 41:15-22. [PMID: 23948617 DOI: 10.3810/hp.2013.08.1064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In certain health care systems, patients wait for non-emergency services. Although waiting may not be considered acceptable, the delay may allow for patient optimization, such as giving time for "toxic" agents to be cleared, that could improve outcomes. We sought to determine the relationship between wait times and outcomes in in-hospital patients undergoing urgent coronary artery bypass graft (CABG) surgery. METHODS AND RESULTS A prospectively collected database of consecutive, medically urgent, but clinically stable patients undergoing CABG surgery from 1995 to 2007, was analyzed. A total of 3067 patients with need for urgent CABG surgery with various in-hospital wait times (n = 440, 0-2 days; n = 799, 3-5 days; n = 1317, 6-10 days; n = 511, 11-15 days) were included. There were no differences in mortality, intensive care unit (ICU) or post-surgery hospital length of stay (LOS) among the patient groups. Multivariate logistic regression analysis revealed that wait time was not associated with mortality (P = 0.625). Due to changes in the nonsurgical management of coronary artery disease, a separate analysis of patients, from 2002 to 2007, was also performed to explore contemporary results. In the latter subset, 1495 patients (n = 175, 341, 720, 259, in the same 4 respective wait-time groups) were included; the 0-2 days patient group underwent more blood transfusions (50% vs 38%; P = 0.01), prolonged ventilation (6% vs 2%; P = 0.05), post-operative dialysis (2% vs 0%; P = 0.08), and longer ICU LOS (26 vs 23 hours; P = 0.02) compared with the 3-5 days patient group. The Society of Thoracic Surgeons mortality risk scores of the 0-2 days and 3-5 days groups were the same (1.5%). Multivariate regression analysis revealed that increased wait time was associated with fewer patients requiring blood transfusion (P < 0.05) for CABG surgery. CONCLUSION Waiting for in-hospital urgent CABG surgery does not lead to worse patient outcomes and may, in fact, reduce the procedural and medical risks of postoperative blood transfusions, prolonged ventilation, dialysis, and shorten ICU LOS.
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Affiliation(s)
- Rizwan A Manji
- Department of Surgery; Department of Anaesthesia, Cardiac Sciences Program, University of Manitoba, Winnipeg, Manitoba, Canada.
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Riera M, Ibáñez J, Molina M, Sáez de Ibarra J, Herrero J, Carrillo A, Campillo C, Bonnín O. Anemia preoperatoria en la cirugía coronaria: ¿un factor de riesgo? Med Intensiva 2009; 33:370-6. [DOI: 10.1016/j.medin.2009.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/09/2009] [Accepted: 04/20/2009] [Indexed: 11/28/2022]
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